Select a managed care plan such as a health maintenance organization (HMO), preferred

provider organization (PPO), point-of-service (POS), or exclusive provider organization

(EPO). Discuss the features, advantages, and disadvantages of your selected managed care

plan. 

A health maintenance organization, or HMO, is a kind of benefits package that hires doctors and

healthcare institutions to provide health treatment to the HMO's members. Because of its cheaper

cost and wider accessibility to healthcare care, HMO coverage is among the most often used

insurance policies. Since their primary care provider is frequently already included in the HMO

network, customers frequently choose an HMO insurance plan. HMO insurance policies function

via a network. The network is a collection of medical professionals with whom your insurer has

contracts. HMO plans often only pay for treatment delivered by specific medical

professionals, labs, and institutions. One possible exception is urgent medical care.

Explain the main features of a consumer-directed health plan (CDHP). 

Contrarily, CDHPs are health coverage plans which raise customer responsibility for overall

healthcare expenditure by combining high deductibles with tax-advantaged individual

expenditure - based arrangements. Insurance policies known as CDHPs use high deductibles and

tax-advantaged individual healthcare spending balances to make consumers more responsible for

their medical expenses. For instance, savings accounts for health care can assist users with the

treatment and avoidance of long-term illnesses. The CDHPs and Health Savings Accounts are

combined (HSAs). Members of HSAs are able to make tax-free deposits into a deposit account to

be utilized for medical costs. To cover eligible medical costs, one needs to use an HSA.
Assume the role of the decision-maker looking for a health plan for your family. Select one

of the plans among HMO, PPO, POS, EPO, or CDHP. Discuss the rationales of your

selected plan in terms of (a) covered benefits, (b) choice of providers, and (c) level of cost

sharing.

I am a decision-maker for the health plans policies of my family and I am determined on

choosing HMO, specifically, United Health Care. I chose premium plan of 80/20 with high

deductibles. Additionally, I chose the plan with 20% discount on any affiliated facility and

wherein ER visit and surgery visits are 80 percent covered as long as requirements are met. With

the needs of my family for allergies’ care and dermatology specialist, this plan is effective. The

cost of an HMO's health insurance coverage might be either monthly or year, but I pay Bi-

Weekly. The HMO restricts its members' utilization of healthcare to services delivered by a

community of physicians and other healthcare professionals who have agreements only with

HMO. As the medical professional’s benefit from having people referred to themselves, such

contracts enable rates to be reduced than those for typical medical insurance (Hayes, 2022). This

is due to your ability to pick the Primary care physician, who is in charge of overseeing overall

treatment and medical care. Furthermore, this expert will promote treatment and care personally.

This involves offering you with recommendations for expert consultants. An HMO plan typically

offers higher-quality healthcare. This is due to the fact that individuals are urged to obtain yearly

checkups and receive medical care as soon as possible. Companies do, nevertheless, impose

more limitations on HMO participants. The initial and most evident benefit of joining an HMO is

the affordable price. Fixed rates that are less expensive than those for conventional insurance

coverage will be paid on an annual or monthly schedule. The co-pays are significantly smaller

compared to different policies, and these policies frequently have minimal or no deductibles.
You will almost certainly have had to communicate with the provider directly as well (Hayes,

2022).

Patient Protection and Affordable Care Act of 2010 

The Affordable Care Act marks a turning point in American healthcare policy. The Legislation

provides the key legislative safeguard that were previously lacking through a sequence of

modifications and amendments to the several statutes that collectively make up the nationwide

legal foundation for the U.S. healthcare system (Ercia, 2021). Around 94% of Americans will

have medical insurance as nothing more than a byproduct of the bill, which will also see a 31

million decrease in the number of people without coverage of an insurance and a 15 million

beneficiary increase in Medicaid membership (Rosenbaum, 2011). It is anticipated that 24

million individuals will continue to be uninsured. In addition to establishing an additional,

inexpensive medical insurance marketplace for individuals and households without cheap

workplace covering or perhaps another type of "bare minimum required protection," the Act also

improves the current kinds of medical healthcare insurance.

Future Trends

An efficient handling must go along with the various components of health care initiatives,

including such payment structures, participants, and strategies. Sedevich-Fons (2014) argues that

having a quality management system is crucial. As was previously said, there are many processes

that involve a number of steps, including preparing and executing a strategy, assets management,

identifying therapeutic approaches, and tracking and enhancing the system. The assessment and

procedure for this approach would be centered on client experience, procedural effectiveness, as

well as the effectivity of the amenities offer

 References

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enrollees. Health Services Research, 55(1), 119–127. https://doi.org/10.1111/1475-

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Ercia, A. (2021). The impact of the affordable care act on patient coverage and access to care:

Perspectives from FQHC administrators in Arizona, California and Texas. BMC Health

Services Research, 21(1). https://doi.org/10.1186/s12913-021-06961-9

Hayes, A. (2022, December 25). Health Maintenance Organization (HMO): What it is, Pros and

Cons. Investopedia. Retrieved March 5, 2023, from

https://www.investopedia.com/terms/h/hmo.asp

Hudson, S., Perigo, D., & Oeding, J. (2017). An assessment of high deductible health plans and

affiliated savings accounts in the current market. International Journal of Healthcare

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Rosenbaum S. (2011). The Patient Protection and Affordable Care Act: implications for public

health policy and practice. Public health reports (Washington, D.C. : 1974), 126(1), 130–

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Sedevich-Fons, L. (2014). Financial indicators in Healthcare Quality Management Systems. The

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